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. 2021 Jan;10(2):595-604.
doi: 10.1002/cam4.3628. Epub 2020 Dec 1.

Prediction of the World Health Organization Grade of rectal neuroendocrine tumors based on CT histogram analysis

Ping Liang  1 , Chuou Xu  1 , Fangqin Tan  1 , Shichao Li  1 , Mingzhen Chen  1 , Daoyu Hu  1 , Ihab Kamel  2 , Yaqi Duan  3 , Zhen Li  1
Affiliations

Prediction of the World Health Organization Grade of rectal neuroendocrine tumors based on CT histogram analysis

Ping Liang et al. Cancer Med. 2021 Jan.

Abstract

Objectives: To investigate the diagnostic value of contrast-enhanced computed tomography (CECT) histogram analysis in predicting the World Health Organization (WHO) grade of rectal neuroendocrine tumors (R-NETs).

Materials and methods: A total of 61 (35 G1, 12 G2, 10 G3, and 4 NECs) patients who underwent preoperative CECT and treated with surgery to be confirmed as R-NETs were included in this study from January 2014 to May 2019. We depicted ROIs and measured the CECT texture parameters (mean, median, 10th, 25th, 75th, 90th percentiles, skewness, kurtosis, and entropy) from arterial phase (AP) and venous phase (VP) images by two radiologists. We calculated intraclass correlation coefficient (ICC) and compared the histogram parameters between low-grade (G1) and higher grade (HG) (G2/G3/NECs) by applying appropriate statistical method. We obtained the optimal parameters to identify G1 from HG using receiver operating characteristic (ROC) curves.

Results: The capability of AP and VP histogram parameters for differentiating G1 from HG was similar in several histogram parameters (mean, median, 10th, 25th, 75th, and 90th percentiles) (all p < 0.001). Skewness, kurtosis, and entropy on AP images showed no significant differences between G1 and HG (p = 0.853, 0.512, 0.557, respectively). Entropy on VP images was significantly different (p = 0.017) between G1 and HG, however, skewness and kurtosis showed no significant differences (p = 0.654, 0.172, respectively). ROC analysis showed a good predictive performance between G1 and HG, and the 75th (AP) generated the highest area under the curve (AUC = 0.871), followed by the 25th (AP), mean (VP), and median (VP) (AUC = 0.864). Combined the size of tumor and the 75th (AP) generated the highest AUC.

Conclusions: CECT histogram parameters, including arterial and venous phases, can be used as excellent indicators for predicting G1 and HG of rectal neuroendocrine tumors, and the size of the tumor is also an important independent predictor.

Keywords: computed tomography; histogram analysis; the grade rectal neuroendocrine tumors.

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Conflict of interest statement

The authors of this manuscript declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study population
FIGURE 2
FIGURE 2
Bar charts showed the comparison of CT histogram parameters for arterial phase (A) and venous phase (B) between G1 and higher grade (HG)
FIGURE 3
FIGURE 3
ROC curves for CT histogram parameters in differentiating G1 from higher grade (HG) at arterial phase (A) and venous phase (B) of enhanced CT scan. Combined the size of tumor and the 75th Percentile generated the highest AUC (C)
FIGURE 4
FIGURE 4
A 51‐year‐old male with G1 R‐NETs. The tumor was significantly enhanced on the arterial phase image (A), and the degree of enhancement is reduced on the venous phase image (D). The tumor region of interest (ROI) was localized on axial CT images at arterial phase (B) and venous phase (E). CT histogram at arterial phase (C) and venous phase (F) were shown
FIGURE 5
FIGURE 5
A 54‐year‐old female with G2 R‐NETs. The tumor was significantly enhanced on the arterial phase image (A), and the degree of enhancement is reduced on the venous phase image (D). The tumor region of interest (ROI) was localized on axial CT images at arterial phase (B) and venous phase (E). CT histogram at arterial phase (C) and venous phase (F) were shown.
FIGURE 6
FIGURE 6
A 56‐year‐old male with G3 R‐NETs. The tumor was significantly enhanced on the arterial phase image (A), and the degree of enhancement is reduced on the venous phase image (D). The tumor region of interest (ROI) was localized on axial CT images at arterial phase (B) and venous phase (E). CT histogram at arterial phase (C) and venous phase (F) were shown
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